外科手术治疗肝癌合并门静脉癌栓的疗效分析

目的 探讨肝细胞癌（HCC）合并门静脉癌栓（PVTT）患者行外科手术治疗的疗效。方法 收集1998年1月至2008年12月34例经手术治疗的HCC合并PVTT患者的临床诊治资料并进行回顾性分析。结果 34例HCC合并PVTT患者术后1个月内死亡2例，32例恢复良好。获随访29例（90.6％），中位生存时间为16.2个月，1、2、3、4、5年生存率分别为51.7％、37.9％、24.1％、10.3％和3.4％。其中术后行门静脉及肝动脉双置管灌注化疗者23例，1、2、3、4、5年的生存率分别为57.1％、42.9％、28.6％、14.3％和4.7％，中位生存时间为19.6个月；单纯手术组9例，1、2、3、4、5年的生存率分别为45.0％、22.2％、11.1％、0、0，中位生存时间为13.5个月。两组生存率比较，差异有统计学意义（P＜0.05）。结论 肝切除加PVTT摘除术是治疗HCC合并PVTT有效的方法之一，术后门静脉和肝动脉双置管灌注化疗能提高患者远期生存率。

Clinical analysis of surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus

Objective To investigate the efficacy of surgical treatment of hepatocellular carcinoma （HCC） with portal vein tumor thrombi（PVTF）. Methods From January 1998 to December 2008, the data of 34 patients of hepatoeellular carcinoma with PVTT who had undergone operation were analyzed retrospectively. Results There were 2 cases of death within one month after opera- tion,32 patients gained good recovery. Twenty-nine cases were followed up （90. 6% ） , the median survival time was 16. 2 months, the o- verall 1 -,2-,3-,4-,5-year survival rates were 51.7 % , 37.9% ,24. 1% , 10. 3 % and 3.4% , respectively. There were 23 patients who reeevied portal vein （PV） and hepatic artery catheterizing chemotherapy ; the overall 1 -, 2-, 3-, 4-, 5-year survival rates were 57.1% , 42. 9% ,28.6% ,14. 3% and 4. 7% ,respectively. The median survival time was 19. 6 months. There were 9 patients with only surgical operation; the overall 1-,2-,3-,4-,5-year survival rates were 45.0% ,22. 2%, 11. l% ,0 and 0, respectively. The median survival time was 13.5 months. There were statistical differences between two groups （P 〈 0. 05 ）. Conclusion Resection of HCC and removal of tumor thrombus in the portal vein is an effective method for hepatocellular carcinoma with tumor thrombus in the portal vein. Postop- erative catheterizing chemotherapy may increase survival rates.